MEDICARE: DR. TATIANA YBARRA PSY D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist
2	225C00000X	Rehabilitation Counselor

General Provider Information

NPI Number	:	1760836928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TATIANA YBARRA PSY D.

Provider Business Mailing Address
First Line	:	9003 RESEDA BLVD
Second Line	:	SUITE 103
City	:	NORTHRIDGE
State	:	CA
Zip	:	91324-3920
Country	:	US
Telephone Number	:	818-465-9368
Fax Number	:	818-921-4182

Provider Business Practice Location Address
First Line	:	9003 RESEDA BLVD
Second Line	:	SUITE 103
City	:	NORTHRIDGE
State	:	CA
Zip	:	91324-3920
Country	:	US
Telephone Number	:	818-465-9368
Fax Number	:	818-921-4182

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2016
Last Update Date	:	12/12/2016

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